Application for Training Waiver
Instructions:
Step 1: Save this training waiver application as a word document.
Step 2: Enter data on the saved document. Include dates of work experience and training.
Step 3: Save completed application.
Step 4: Email completed training waiver application as an attachment to Adell Moore at: .
Step 5: Application must be verified & submitted by the supervisor & approved by the CountyDirector or designee.
Final decision will be sent to whoever submitted the application and to the case manager.
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Date of request:Most Recent Hire Date:
Is applicant registered for New Worker Training? (Y/N) Date of training:
Is applicant a certified case manager? (Y/N) Certification Program Area/Date:
CM Name: Last: First: Middle:
CM Phone Number: CM Email:
County: Region:
Has there been a break in service? (Y/N) How long?
Program Area(s) assigned: CPS FC Adoption RD
Position: (Check one)Case Manager
Case Manager Advanced
Case Manager Specialist
Supervisor: Phone Number:
A. Education
Degree(s): Date obtained:
College/University from which degree obtained:
List any Internship Experience with DFCS:
When?
Where?
Number of semesters of internship
Number of hours total in internship
In what program area(s) did you complete your internship?
If a IV-E graduate of a Georgia School of Social Work, list the 2 Child Welfare Courses that
you successfully completed for your BSW/MSW?
1.
2.
B. Previous experience as a full time public child welfare worker for DFCS or another state’s public child welfare agency.
Agency Name:Location:
County DFCS office:
Dates of Employment:
Previously managed a caseload? (answer yes or no)
In what program area?
Beginning and ending dates of work in managing a caseload to
Agency Name:
County DFCS office:
Dates of Employment:
Previously managed a caseload? (answer yes or no)
In What Program Area?
Beginning and ending dates of work in managing a caseload to
C. Previous child welfare training attended in GEORGIA?
Place an x in front of the course(s) you successfully completed and the date of completion after the course name:
Fundamentals
Foundations
Keys Training
Online Training
1) How to use the Training System
2) Roadmap to Successful Online Training
3)New Worker Orientation to DFCS/DFCS
4) Introduction to Child Welfare Services
5)Substance Abuse
6) Child Care
7) CFSR Overview Documentation
CPS Track/Application Legal
Online Track Training Other
1)Intake
2)Investigations
3)Family Perservation (Ongoing)
FC Track /Application GA SHINES
Online Track Training : Books 1-19
D. COMPLETE only if you are a veteran case manager changing program areas.
Place an x in front of the course(s) you successfully completed and the date of completion after the course name:
Fundamentals
Foundations
Keys Training
Keys Online Training
1) How to use the Training System
2) Roadmap to Successful Online Training
3)New Worker Orientation to DFCS/DFCS
4) Introduction to Child Welfare Services
5) Substance Abuse
6) Child Care
7) CFSR Overview Documentation
CPS Track/Application Legal
Online Track Training Other
1)Intake
2)Investigations
3)Family Perservation (Ongoing)
FC Track /Application GA SHINES
Online Track Training : Books 1-19
E. Previous child welfare training attended in another state (Specify state and list courses and completion dates for each):
F. Other information that will assist us in making a waiver decision:
G. Signature and Email address:
We are requesting that the above-named employee be exempted from all or part of the training sequence for new staff. In our opinion he/she has the knowledge and skills to perform the duties for the position hired without attending all of the required new worker training. The county director, supervisor, and case manager have discussed the waiver request and all are in agreement with this waiver request.
(Supervisor or County Director's Name, Email address, and Date)
My name typed here is equivalent to my signature on this document.
Please email to Education and Training Services Section, Adell Moore,
Revised June 2008